Importance: Pure-tone audiometry and speech understanding tests are commonly used in clinical audiology but fail to capture communication challenges and daily-life difficulties experienced by individuals with hearing loss (HL), limiting the personalization of care.

Objective : To determine whether integrating Patient-Reported Outcome Measures (PROMs) into audiological practice can reveal specific functional and psychosocial needs not captured by traditional audiological tests.

Design: We conducted a population-based cross-sectional analysis on data collected between September 1, 2020, and December 31, 2022.

Setting: Multicentred study involving 700 audiology clinics across France.

Participants: A total of 91,297 adults aged 18 to 99 years with symmetrical HL were included based on the completeness of audiometric and PROMs data.

Exposures: Hearing loss severity, assessed using Pure-Tone Average (PTA) thresholds (500, 1000, 2000, and 4000 Hz) along with speech tests in quiet (Speech Reception Threshold, SRT) and in noise (Signal-to-Noise Ratio, SNR). PROMs were collected using the Client Oriented Scale of Improvement (COSI), where patients identified up to five listening situations for improvement with hearing aids.

Main Outcomes and Measures: The primary outcome was the association between specific PROMs and PTA. Regression models were used to identify significant PROMs-related predictors of hearing loss severity.

Results: The sample was gender-balanced (44,525 females; 46,762 males) with a mean age of 72.1 years (SD, 11.8). Most (81%) had mild to moderate HL (mean PTA 42.9 dB HL; SD, 11.3). Among 273,861 PROMs responses, individuals with slight to moderate HL revealed a wide range of clinical needs—such as increased social contact or avoiding embarrassment—that varied significantly by age and sex and were not explained by audiometric thresholds. In contrast, for those with severe to profound HL, needs were more homogeneous and primarily driven by PTA.

Conclusions and Relevance: PROMs identify specific, patient-reported needs that are not captured by conventional audiological measures—especially in slight to moderate HL where individual variability is high. Their integration into routine care provides a strong rationale for improving the management of milder HL and supports more personalized and effective rehabilitation strategies.